Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 1

LITTERATURDATABASE FOR KOMPETANSETJENESTEN FOR

SYKDOMSRELATERT UNDERERNÆRING

INNHOLD

Underernæring .......................................................................................................................... 2

Definisjoner og kriterier ................................................................................................................................... 2

Prevalens (ernæringsrisiko og/eller underernæring) ..................................................................................... 2

Årsaker og risikofaktorer til underernæring ................................................................................................. 3

Konsekvenser av underernæring .................................................................................................................... 3

Screening ................................................................................................................................... 5

Screening og kartleggingsverktøy (med lenker til hvor de finnes) ............................................................... 5

MNA (SF) ...................................................................................................................................................... 5

MUST ............................................................................................................................................................. 6

NRS-2002 ....................................................................................................................................................... 6

PG-SGA ......................................................................................................................................................... 6

SNAQ ............................................................................................................................................................. 7

Effekt av screening ........................................................................................................................................... 7

Does nutrition support help those screened positive? .................................................................................... 7

Effekt av ernæringsintervensjoner ........................................................................................... 8

Implementering av ernæringsstrategier/PROGRAM .............................................................. 9

Barrierer og suksessfaktorer ........................................................................................................................... 9

Kvalitetsindikatorer ....................................................................................................................................... 10

Kostnad nytte ........................................................................................................................... 10

VEDLEGG ................................................................................................................................................... 12

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 2

UNDERERNÆRING

Stratton RG, C.J.; Elia, M. Disease-related malnutrition: An Evidence-Based Approach

To Treatment CABI publishing; 2003.

DEFINISJONER OG KRITERIER

Jensen GL, Mirtallo J, Compher C, Dhaliwal R, Forbes A, Grijalba RF, et al.

Adult starvation and disease-related malnutrition: a proposal for etiologybased

diagnosis in the clinical practice setting from the International Consensus Guideline

Committee.

Clinical nutrition. 2010;29(2):151-3.

ASPEN/AND

White JV, Guenter P, Jensen G, Malone A, Schofield M, Academy Malnutrition Work G, et

al. Consensus statemet: Academy of Nutrition and Dietetics and American Society for

Parenteral and Enteral Nutrition: characteristics recommended for the identification

and documentation of adult

malnutrition (undernutrition).

JPEN Journal of parenteral and enteral nutrition. 2012;36(3):275-83.

ESPEN

Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M,

Nyulasi I, Ockenga J, Schneider SM, de van der Schueren MA, Singer P.

Diagnostic criteria for malnutrition - An ESPEN Consensus Statement.

Clin Nutr. 2015 Jun;34(3):335-40.

Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, Strasser F, Thoresen L,

Jagoe RT, Chasen M, Lundholm K, Bosaeus I, Fearon KH, Baracos VE.

Diagnostic criteria for the classification of cancer-associated weight loss.

J Clin Oncol. 2015 Jan 1;33(1):90-9. doi: 10.1200/JCO.2014.56.1894. Epub 2014 Nov 24.

PREVALENS (ERNÆRINGSRISIKO OG/ELLER UNDERERNÆRING)

Martins CP, Correia JR, do Amaral TF.

Undernutrition risk screening and length of stay of hospitalized elderly. Journal of nutrition for the elderly. 2005;25(2):5-21.

Singh H, Watt K, Veitch R, Cantor M, Duerksen DR.

Malnutrition is prevalent in hospitalized medical patients: are housestaff identifying the

malnourished patient? Nutrition. 2006;22(4):350-4.

Bauer JD, Isenring E, Torma J, Horsley P, Martineau J.

Nutritional status of patients who have fallen in an acute care setting.

Journal of human nutrition and dietetics : the official journal of the British Dietetic

Association. 2007;20(6):558-64.

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 3

Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krahenbuhl L, Meier R, et al.

EuroOOPS: an international, multicentre study to implement nutritional

risk screening and evaluate clinical outcome. Clinical nutrition. 2008;27(3):340-9.

Imoberdorf R, Meier R, Krebs P, Hangartner PJ, Hess B, Staubli M, et al.

Prevalence of undernutrition on admission to Swiss hospitals. Clinical nutrition. 2010;29(1):38-41.

Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al.

Frequency of malnutrition in older adults: a multinational perspective using

the mini nutritional assessment. Journal of the American Geriatrics Society. 2010;58(9):1734-8.

Tangvik RJ, Guttormsen AB, Tell GS, Ranhoff AH.

Implementation of nutritional guidelines in a university hospital monitored by repeated

point prevalence surveys.

Eur J Clin Nutr. 2012 Mar;66(3):388-93

Tangvik RJ, Tell GS, Guttormsen AB, Eisman JA, Henriksen A, Nilsen RM, Ranhoff AH:

Nutritional risk profile in a university hospital population. Clin Nutr. 2015 Aug;34(4):705-11.

Eide HK, Benth JS, Sortland K, Halvorsen K, Almendingen K.

Prevalence of nutritional risk in the non.demented hospital elderly: a cross-sectional

study from Norway using stratified sampling.

J Nutr Sci. 2015 May 6;4:e18.

Jacobsen EL, Brovold T, Bergland A, Bye A.

Prevalence of factors associated with malnutrition among acute geriatric patients in

Norway: a cross-sectional study.

BMJ Open 2016;6:e011512. doi:10.1136/bmjopen-2016-011512

ÅRSAKER OG RISIKOFAKTORER TIL UNDERERNÆRING

Kommer

KONSEKVENSER AV UNDERERNÆRING

Cosqueric G, Sebag A, Ducolombier C, Thomas C, Piette F, Weill-Engerer S.

Sarcopenia is predictive of nosocomial infection in care of the elderly.

The British journal of nutrition. 2006;96(5):895-901.

Mowe M, Diep L, Bohmer T.

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 4

Greater seven-year survival in very aged patients with body mass index between 24 and

26 kg/m2. Journal of the American Geriatrics Society. 2008;56(2):359-60.

Juliebo V, Bjoro K, Krogseth M, Skovlund E, Ranhoff AH, Wyller TB.

Risk factors for preoperative and postoperative delirium in elderly patients with hip

fracture.

Journal of the American Geriatrics Society. 2009;57(8):1354-61.

Hartholt K.A., van Beeck E.F., Polinder S., van der Velde N., van Lieshout E.M., Panneman

M.J., van der Cammen T.J., Patka P.

Societal consequences of falls in the older population: injuries, healthcare costs, and

long-term reduced quality of life.

J Trauma. 2011 Sep.; 71(3):748-53. doi: 10.1097/TA.0b013e3181f6f5e5. PubMed PMID:

21045738.

Barker LA, Gout BS, Crowe TC.

Hospital malnutrition: prevalence, identification and impact on patients and the

healthcare system.

International journal of environmental research and public health. 2011;8(2):514-27.

Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE.

Sarcopenia is associated with postoperative infection and delayed recovery from

colorectal cancer resection surgery.

British journal of cancer. 2012;107(6):931-6.

Krell RW, Kaul DR, Martin AR, Englesbe MJ, Sonnenday CJ, Cai S, et al.

Association between sarcopenia and the risk of serious infection among adults

undergoing liver transplantation.

Liver transplantation : official publication of the American Association for the Study of Liver

Diseases and the International Liver Transplantation Society. 2013;19(12):1396-402.

Tangvik RJ, Tell GS, Eisman JA, Guttormsen AB, Henriksen A, Nilsen RM, Øyen J, Ranhoff

AH.

The nutritional strategy: four questions predict morbidity, mortality and health care

costs.

Clin Nutr. 2014 Aug;33(4):634-41

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 5

SCREENING

Kelly IE, Tessier S, Cahill A, Morris SE, Crumley A, McLaughlin D, McKee RF, Lean ME.

Still hungry in hospital: identifying malnutrition in acute hospital admissions.

QJM. 2000 Feb;93(2):93-8.

AUTHORS' CONCLUSIONS: Malnutrition in acute hospital admissions goes apparently

unrecognized and unmanaged in 70% of cases. Since there are serious consequences, and

effective simple treatment is readily available, increased awareness is required, with routine

assessment of nutritional status in all patients.

SCREENING OG KARTLEGGINGSVERKTØY (MED LENKER TIL HVOR DE

FINNES)

MNA (SF)

Mini Nutritional Assessment er et kartleggingsverktøy som fører til vurderingene «Normal

ernæringsstatus», «Risiko for undernæring» eller «Underernært».

Lenk til norsk oversettelse av MNA

http://www.mna-elderly.com/forms/MNA_norwegian.pdf

Veiledning for utfylling av MNA skjema for ernæringsvurdering

http://www.mna-elderly.com/forms/mna_guide_norwegian.pdf

Veiledningen har følgende vedlegg:

Vedlegg 1 • Tabell over Kroppsmasseindeks

Vedlegg 2 • Regne ut BMI for personer med amputasjon

Vedlegg 3 • Måle høyde ved hjelp av et Stadiometer

Vedlegg 4 • Måle Pemispan

Vedlegg 5 • Måle Knehøyde

Vedlegg 6 • Måle Overarmens Omkrets (OO)

Vedlegg 7 • Måle Leggens Omkrets

17 referanser

Mastronuzzi T, Paci C, Portincasa P, Montanaro N, Grattagliano I.

Assessing the nutritional status of older individuals in family practice: Evaluation and

implications for management.

Clin Nutr. 2015 Dec;34(6):1184-8. doi: 10.1016/j.clnu.2014.12.005. Epub 2014 Dec 17.

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 6

MUST

Malnutrition Universal Screenings Tool er et verktøy som vurderer risikoen for underernæring

og skårer pasientene i «Lav risiko», «Middels risko» eller «Høy risiko» for underernæring.

Lenk til norsk oversettelse av MUST

http://www.nutricia.no/images/uploads/3._MUST_flytskjema.pdf

Lenk til veiledning for utfylling av MUST

http://www.nutricia.no/images/uploads/MUST_brosjyre_32_sider.pdf

13 referanser

NRS-2002

Nutrition Risk screening 2002

J. Kondrup, S. P. Allison, M. Elia, B.Vellas, M. Plauth

ESPEN Guidelines for Nutrition Screening 2002

Clinical Nutrition (2003) 22(4): 415–421

Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, Liberda M;

EuroOOPS study group.

EuroOOPS: an international, multicentre study to implement nutritional risk screening

and evaluate clinical outcome.

Clin Nutr. 2008 Jun;27(3):340-9. doi: 10.1016/j.clnu.2008.03.012. Epub 2008 May 27.

Norsk oversettelse

5.utgave, januar 2015 er rett oversettelse fra original publikasjon.

http://www.fresenius-

kabi.no/Documents/Open%20files/NO/EN/God_ern%C3%A6ringspraksis_lommebrosjyre.pd

f

PG-SGA

The Scored Patient-Generated Subjective Global Assessment

Det er mange versjoner av SGA oversatt til ulike språk. PG-SGA inneholder elementene i

screeningsverktøy og kan derfor fungere både som screening og kartleggingsverktøy.

PG-SGA setter i dag standarden og er det foretrukne verktøyet innen onkologi og ved andre

kronisk katabolske tilstander. PG-SGA er et kartleggingsverktøy som gir tilstandene

velernært, moderat underernært eller alvorlig underernært.

Norsk oversettelse

Vil komme på nettsiden til Pt-Global

http://pt-global.org/?page_id=13

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 7

SNAQ

Short Nutritional Assessment Questionnaire (SNAQ) er ikke oversatt til norsk. Det finnes

flere varianter av SNAQ for bruk på ulike nivåer av helsetjenestene og for ulike

aldersgrupper.

Lenk til SNAQ verktøyene

http://www.fightmalnutrition.eu/fight-malnutrition/screening-tools/snaq-tools-in-english/

EFFEKT AV SCREENING

Omidvari AH, Vali Y, Murray SM, Wonderling D, Rashidian A.

Nutritional screening for improving professional practice for patient outcomes in

hospital and primary care settings.

Cochrane Database Syst Rev. 2013 Jun 6;6:CD005539. doi:

10.1002/14651858.CD005539.pub2. Review.

AUTHORS' CONCLUSIONS: Current evidence is insufficient to support the effectiveness

of nutritional screening, although equally there is no evidence of no effect. Therefore, more

high quality studies should be conducted to assess the effectiveness of nutritional screening in

different settings.

DOES NUTRITION SUPPORT HELP THOSE SCREENED POSITIVE?

Starke J, Schneider H, Alteheld B, Stehle P, Meier R.

Short-term individual nutritional care as part of routine clinical setting improves

outcome and quality of life in malnourished medical patients.

Clin Nutr. 2011 Apr;30(2):194-201. doi: 10.1016/j.clnu.2010.07.021.

AUTHORS' CONCLUSIONS: Malnourished patients profit from nutrition support

regarding nutrition status and quality of life. They have fewer complications, need fewer

antibiotics and are less often re-hospitalised.

Johansen N, Kondrup J, Plum LM, Bak L, Nørregaard P, Bunch E, Baernthsen H, Andersen

JR, Larsen IH, Martinsen A.

Effect of nutritional support on clinical outcome in patients at nutritional risk.

Clin Nutr. 2004 Aug;23(4):539-50.

AUTHORS' CONCLUSIONS: Protein and energy intake of nutritionally at-risk patients

was increased which resulted in shortening of the part of the length of stay that was

considered to be sensitive to nutritional support (LOSNDI) and shorter length of stay (LOS)

among patients with complications.

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 8

EFFEKT AV ERNÆRINGSINTERVENSJONER

Stratton RG, C.J.; Elia, M. Disease-related malnutrition: An Evidence-Based Approach

To Treatment CABI publishing; 2003.

Evidence for nutrition support

Meta-analysis of 27 RCT with 1710 patients (complications)

30 RCT with 3250 patients (mortality)

Complications 28% vs 46% (P<0.001)

Mortality 17% vs 24% (P<0.001)

Duncan DG, Beck SJ, Hood K, Johansen A.

Using dietetic assistants to improve the outcome of hip fracture: a randomised

controlled trial of nutritional support in an acute trauma ward. Age and ageing.

2006;35(2):148-53.

AUTHORS' CONCLUSIONS: Dietetic or nutrition assistants are being introduced in units

across the UK. This, the largest ever study of nutritional support after hip fracture, shows that

their employment significantly reduced patients' risk of dying in the acute trauma unit; an

effect that persisted at 4 month follow-up.

Ha L, Hauge T, Spenning AB, Iversen PO.

Individual, nutritional support prevents undernutrition, increases muscle strength and

improves QoL among elderly at nutritional risk hospitalized for acute stroke: a

randomized, controlled trial.

Clin Nutr. 2010 Oct;29(5):567-73

AUTHORS' CONCLUSIONS: Individualized, nutritional treatment strategy can prevent

clinically significant weight loss and improve QoL in elderly acute stroke patients at

nutritional risk.

Somanchi M1, Tao X, Mullin GE.

The facilitated early enteral and dietary management effectiveness trial in hospitalized

patients with malnutrition.

JPEN J Parenter Enteral Nutr. 2011 Mar;35(2):209-16. doi: 10.1177/0148607110392234.

Holyday M, Daniells S, Bare M, Caplan GA, Petocz P, Bolin T.

Malnutrition screening and early nutrition intervention in hospitalised patients in acute

aged care: a randomised controlled trial. J Nutr Health Aging. 2012;16(6):562-8.

AUTHORS' CONCLUSIONS: Without screening, clinical staff identified only a small

proportion of malnourished patients (35% of MN and 20% of AR). Malnutrition in the older

hospital population is common. Malnutrition screening on hospital admission facilitated

targeted nutrition intervention, however length of stay and re-presentations were only

reduced in older malnourished patients with an MNA score less than 17.

Beck A, Andersen UT, Leedo E et al

Does adding a dietician to the liaison team after discharge of geriatric patients improve

nutritional outcome: A randomized controlled trial

Clin Rehabil, 2014;29:1117-28

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 9

IMPLEMENTERING AV ERNÆRINGSSTRATEGIER/PROGRAM

Guenter P, Jensen G, Paten V et al

Addressing Disease-Related Malnutrition in Hospitalized Patients: A call for a National

Goal

The Joint Commission Journal on Quality and Patient Safety, 2015; 41:469-473

Brugler L, DiPrinzio MJ, Bernstein L.

The five-year evolution of a malnutrition treatment program in a community hospital.

Jt Comm J Qual Improv. 1999 Apr;25(4):191-206.

BARRIERER OG SUKSESSFAKTORER

Food and nutritional care in hospitals: How to prevent undernutrition.

Strasbourg: Council of Europe Publishing; 2002

Cahill NE, Suurdt J, Ouellette-Kuntz H, Heyland DK.

Understanding adherence to guidelines in the intensive care unit: development of a

comprehensive framework.

JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34:616-24.

Holst M, Rasmussen HH.

Nutrition Therapy in the Transition between Hospital and Home: An Investigation of

Barriers.

J Nutr Metab. 2013;2013:463751. doi: 10.1155/2013/463751. Epub 2013 Dec 29.

Juul HJ, Frich JC.

Kartlegging av underernæring i sykehus. Hva hemmer og fremmer sykepleieres bruk av

screeningverktøy for identifisering av ernæringsmessig risiko?

Nordisk Sygeplejeforskning 2013;3:77-89

Stamp N, Davis AM

Identifying barriers to implementing nutrition recommendation

Topics in Clin Nutr, 2013; 28:249-261

Leistra, E., van Bokhorst-de van der Schueren, M. A., Visser, M., van der Hout, A., Langius,

J. A., Kruizenga, H. M.,

Systematic screening for undernutrition in hospitals: predictive factors for success

Clin Nutr, 2014;33:495-501

Ekramzadeh M, Mazloom Z, Jafari P, Ayatollahi M, Sagheb MM.

Major barriers responsible for malnutrition in hemodialysis patients: challenges to

optimal nutrition.

Nephrourol Mon. 2014 Nov 10;6(6):e23158. doi: 10.5812/numonthly.23158.

Eide HD, Halvorsen K, Almendingen K.

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 10

Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of

nurses.

J Clin Nurs. 2015 Mar;24(5-6):696-706. doi: 10.1111/jocn.12562. Epub 2014 Mar 20.

Keller H, Allard J, Vesnaver E, Laporte M, Gramlich L, Bernier P, Davidson B, Duerksen D,

Jeejeebhoy K, Payette H.

Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition

Task Force.

J Hum Nutr Diet. 2015 Dec;28:546-57.

KVALITETSINDIKATORER

van Nie-Visser, N. C., Meijers, J. M., Schols, J. M., Lohrmann, C., Spreeuwenberg, M.,

Halfens, R. J.

To what extent do structural quality indicators of (nutritional) care influence

malnutrition prevalence in nursing homes?

Clin Nutr 2015;34:1172-1176

KOSTNAD NYTTE

C.L. Funk, C.M. Ayton

Improving malnutrition documentation enhances reimbursement

J Am Diet Assoc,1995;95,468–475

Kruizenga H.M., Van Tulder M.W., Seidell J.C., Thijs A., Ader H.J., Van Bokhorst-de van

der Schueren M.A.

Effectiveness and cost-effectiveness of early screening and treatment of malnourished

patients. Am. J. Clin. Nutr. 2005 Nov;82(5):1082-9. PubMed PMID: 16280442.

T.F. Amaral, L.C. Matos, M.M. Tavares, A. Subtil, A. Martins, R. Nazare, et al.

The economic impact of disease-related malnutrition at hospital admission

Clin Nutr, 2007;26:778–784

Karen Freijers avhandling Nutrition Economics Disease related malnutrition & the

economic health care value of medical nutrition kan lastes ned fra denne lenken

http://digitalarchive.maastrichtuniversity.nl/fedora/get/guid:5a5c4ad5-9836-41b3-b86e-

40067eb44e73/ASSET1

Freijer K, Nuijten MJ.

Analysis of the health economic impact of medical nutrition in the Netherlands.

Eur J Clin Nutr. 2010 Oct;64(10):1229-34. doi: 10.1038/ejcn.2010.147. Epub 2010 Aug 18.

Guest JF, Panca M, Baeyens JP, de Man F, Ljungqvist O, Pichard C, Wait S, Wilson L.

Health economic impact of managing patients following a community-based diagnosis of

malnutrition in the UK.

Clin Nutr. 2011;30:422-9

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 11

Norman, K., Pirlich, M., Smoliner, C., Kilbert, A., Schulzke, J. D., Ockenga, J., Lochs, H.

Reinhold, T.Cost-effectiveness of a 3-month intervention with oral nutritional

supplements in disease-related malnutrition: a randomised controlled pilot study

Eur J Clin Nutr, 2011;65: 735-42

Freijer K, Nuijten MJ, Schols JM.

The budget impact of oral nutritional supplements for disease related malnutrition in

elderly in the community setting

Front Pharmacol 2012; 3; 78: 1‐8

Lim, S.L., Ong, K.C., Chan, Y.H., Loke, W.C., Ferguson, M., Daniels, L.

Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-

year mortality. Clinical Nutrition 2012;31,345-350.

Meijers, J.M.M., Halfens, R.J.G., Wilson, L., Schols, J.M.G.A.

Estimating the costs associ-ated with malnutrition in Dutch nursing homes. Clinical Nutrition 2012;31,65-68.

Jie B1, Jiang ZM, Nolan MT, Zhu SN, Yu K, Kondrup J

Impact of preoperative nutritional support on clinical outcome in abdominal surgical

patients at nutritional risk. Nutrition. 2012;28:1022-7.

Freijer K, Tan SS, Koopmanschap MA, Meijers JM, Halfens RJ, Nuijten MJ.

The economic costs of disease related malnutrition.

Clin Nutr. 2013;32:136-41.

Freijer K, Bours MJ, Nuijten MJ, Poley MJ, Meijers JM, Halfens RJ, Schols JM.

The economic value of enteral medical nutrition in the management of disease-related

malnutrition: a systematic review. J Am Med Dir Assoc. 2014;15:17-29.

Freijer K, Lenoir-Wijnkoop I, Russell CA, Koopmanschap MA, Kruizenga HM, Lhachimi

SK, Norman K, Nuijten MJ, Schols JM.

The view of European experts regarding health economics for medical nutrition in

disease-related malnutrition. Eur J Clin Nutr. 2015;69:539-45.

Souzaa TT, Sturiona CJ, Faintuchb J.

Is the skeleton still in the hospital closet? A review of hospital malnutrition emphasizing

health economic aspects

Clinical Nutrition, 2015;34:1088–1092

Elia M, Normand C, Norman K, Laviano A.

A systematic review of the cost and cost effectiveness of using standard oral nutritional

supplements in the hospital setting. Clin Nutr. 2015 May 29. pii: S0261-5614(15)00142-9.

doi: 10.1016/j.clnu.2015.05.010. [Epub ahead of print]

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 12

VEDLEGG

Defininisjoner og kriterier på underernæring

White et al 2012

Since there is no single parameter that is definitive for adult malnutrition, identification of two

or more of the following six characteristics is recommended for diagnosis (see the Table):

• insufficient energy intake (30-32);

• weight loss (33-36);

• loss of muscle mass (36,37);

• loss of subcutaneous fat (36,37);

• localized or generalized fluid accumulation (36,37) that may sometimes mask weight loss;

and

• diminished functional status as measured by hand grip strength (3,36,38-42).

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 13

Kompetansetjenesten for sykdomsrelatert underernæring (3. november 2016) 14

Cederholm et al 2015

Fact box:

Two alternative ways to diagnose malnutrition.

Before diagnosis of malnutrition is considered it is mandatory to fulfil criteria for being “at

risk” of malnutrition by any validated risk screening tool.

Alternative 1:

BMI <18.5 kg/m2

Alternative 2:

Weight loss (unintentional) > 10% indefinite of time, or >5% over the last 3 months

combined with either

BMI <20 kg/m2 if <70 years of age, or <22 kg/m2 if 70 years of age or

FFMI <15 and 17 kg/m2 in women and men, respectively.